Systematic review to determine the prevalence of transmitted drug resistance mutations to rilpivirine in HIV-infected treatment-naive persons

BACKGROUND: Transmitted drug resistance to antiretrovirals in HIV-1 infected individuals is rising in some regions, and could compromise the effectiveness of first-line treatment. It is important to understand the prevalence of resistance to rilpivirine to inform treatment provision. METHODS: A PUBMED/EMBASE search identified analyses of transmitted genotypic resistance to specific NNRTI mutations worldwide. Patients were to be HIV-1 infected and antiretroviral naive. Rilpivirine mutations assessed were: L100I, K101E/P, E138A/G/K/Q/R, V179L, Y181C/I/V, Y188L, H221Y, F227C, and M230I/L. Additionally, frequency of resistance mutations were extracted and pooled by HIV subtype from the Stanford HIV drug resistance database. RESULTS: 138 eligible articles from 65 countries were identified (n=64,466). Among these 64,466 samples, 7 of the 9 genotypic rilpivirine mutations had a prevalence <0.1%. Two mutations were more prevalent: E138A/G/K/Q/R (0.7%, 95%CI 0.2-1.3) and Y181C/I/V (0.3%, 95%CI 0.2-0.4). Prevalence of E138 rilpivirine-related mutations varied between regions: highest in Latin America / Caribbean (3.6%, 95%CI 1.0-7.6) and in Europe (3.2%, 95%CI 0.7-6.9). Pooled results from the Stanford database (n=52,680) correlated with these findings indicating a low prevalence of 8/9 rilpivirine mutations (<0.1%), except for E138A/G/K/Q/R (2.9%, 95%CI 1.8-4.4). Prevalence of the mutations at E138 varied significantly by HIV subtype and was highest for subtype-C (6.1%), subtype-F (5.1%), and subtype-A (3.3%). CONCLUSIONS: The prevalence of most transmitted rilpivirine related HIV mutations is generally low in treatment naive HIV-1 infected individuals (<0.1%). The prevalence of E138A/G/K/Q/R mutations is higher (0.7%) and varies according to geographical region and HIV subtype.

• Population(s)
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment